The invention relates to surgical instruments for performing a surgical procedure on a patient that include at least one integrated electrocautery electrode, and to methods for using the instruments in surgical procedures.
Traditionally, many surgical procedures have been performed on patients using open surgical methods that utilize relatively large incisions to expose a surgical field. Many traditional methods have also typically utilized surgical tools such as scalpels, scrapers, blunt dissectors, lasers, electrosurgical devices, etc., which can have poor tissue differentiating capability and which can sometimes cause inadvertent damage to tissue surrounding a surgical treatment site unless carefully utilized. Open surgery with such prior art surgical instruments often involves extensive trauma to the patient, with associated problems of long recovery periods and potential complications.
There has been a trend in recent years to perform many surgical procedures using less invasive techniques by accessing surgical sites via small holes through the skin or through body orifices. These techniques are known as xe2x80x9cminimally invasive surgery.xe2x80x9d Minimally invasive surgical techniques commonly employed include endoscopic, laparoscopic, and arthroscopic surgical procedures. Minimally invasive surgical procedures are commonly preferred to open surgical procedures for many applications because the minimally invasive procedures induce less trauma to the patient during surgery and involve, in many cases, fewer potential complications and reduced recovery time.
A variety of surgical instruments have been developed and utilized both for minimally invasive surgical procedures and for more traditional open surgical procedures. Frequently used instruments include blade and scalpel-type instruments, motorized rotary cutting and/or grinding instruments, laser instruments, liquid jet cutting instruments, and electrosurgical instruments. Typically, prior art instruments suffer from a variety of disadvantages. For example, typical prior art surgical instruments, especially those utilized for minimally invasive surgical procedures, have distal ends including a single component for performing a particular surgical function. Surgical instruments having distal ends including, for example, a rotating cutting or grinding head, a tissue-ablating laser, a liquid cutting jet, or an electrosurgical cutting jet are known in the art. Many of these prior art instruments suffer from a variety of disadvantages. For example, instruments having a distal end configured to perform only a cutting function must be removed from a surgical field of a patient and replaced with additional instruments if other surgical functions, such as grinding or electrocautery, are required. Similarly, instruments including, for example, a distal end having a grinding component or an electrosurgical or electrocautery component must be removed from a surgical site and exchanged with additional instrumentation for performing other functions, such as surgical cutting, etc. Such a removal and exchange of surgical instruments, especially when performing during minimally invasive surgical procedures, can be undesirable both from the standpoint of the speed and convenience, and also from the standpoint of the safety and effectiveness of the surgical instrument in performing complex surgical procedures requiring multiple tasks to be performed in the surgical operating field.
For a variety of surgical procedures, including a variety of minimally invasive surgical procedures, it is often desirable to utilize a surgical instrument including a rotating component in the surgical field. Instruments providing rotating components may be advantageously utilized for surgical tasks such as grinding, polishing, drilling, cutting with rotating cutting blades, etc. Typical prior art surgical instruments providing rotating shafts for use in surgical procedures typically have employed electric motors to drive rotation of the shafts, or, alternatively, have employed pneumatically driven rotating turbine rotors. Such prior art instruments suffer from a variety of disadvantages. For example, instruments driven by electric motors often create rotation of grinding burrs, or other tissue contacting components connected to the rotating shaft, having relatively poor responsiveness of the rotational speed of the shaft to the resistance and torque applied to the tissue contacting component in the surgical field during operation. This poor responsiveness and feedback can, in some instances, lead to a variety of difficulties such as difficulty in maintaining contact of the rotating tissue contacting component, for example grinding burr, of the device with tissue in a particular desired location within a surgical field (e.g., due to skating or skipping of a grinding burr along the surface being ground), and also can lead to undesirable transmission of torque to a handle or other user interface of the surgical device, potentially causing a lack of operator control and unintended tissue damage.
Pneumatically powered surgical devices providing rotating shafts typically provide better compensation of the rotational speed of the rotating shaft with applied load than electric motor powered instruments; however, pneumatically powered instruments require that surgical instruments be coupled to a source of highly pressurized gas during operation of the instruments, which can be inconvenient, expensive, or undesirable.
U.S. Pat. No. 5,803,733 to Trott et al. describes a pneumatically powered surgical handpiece in which the pressurized fluid inlet is axially directed relative to the handpiece body. The handpiece includes a reaction-type turbine that is rotated by fluid flowing within a closed conduit. The handpiece utilizes a cantilevered turbine rotor, wherein the output shaft of the handpiece and the turbine rotor rotate about axes which are co-linear.
Surgical instruments utilizing liquid-driven turbine rotors are also known. U.S. Pat. No. 4,631,052 to Kensey describes an elongated, flexible recanalization catheter that includes a working head which is adapted to be rotated by a turbine drive in operation. The turbine drive utilizes a liquid-driven turbine rotor comprising a reaction turbine whose rotational motion is imparted by pressure driven liquid flowing in a closed conduit. The turbine rotor and the rotating working head of the device are directly coupled together so that they rotate at essentially the same speed during operation. In addition, the rotor assembly is disposed at the distal end of the catheter and is essentially completely submerged in liquid during operation.
U.S. Pat. No. 4,690,140 to Mecca describes a catheter for use in the removal of deposits lining the interior wall of a blood vessel that includes a rotating cutting device at its distal end. Rotational motion of the rotating cutting device is imparted by flow of a pressure-driven liquid. The cutting surfaces of the rotating cutting device and the turbine rotor comprise a single component rotating at essentially the same speed and about the same rotational axis. As with the ""052 patent described above, the rotating cutting element of the ""140 patent is disposed at the distal end of the catheter such that the turbine rotor causing rotation of the device is essentially completely submerged in liquid during operation.
Surgical instruments providing electrosurgical cutting or cauterizing electrodes in combination with rotating surgical components or liquid perfusion and/or aspiration capabilities are also known.
U.S. Pat. No. 5,527,331 to Kresch describes a tissue resection device for use in an organ inflated with a non-conductive fluid. The distal end of the device can include a perfusion lumen, a rotatable drive tube, and a drive tube aspiration lumen. A cutting tip can be mounted on the distal end of the drive tube. In some configurations, the cutting tip is further configured to act as an electrosurgical resection electrode.
U.S. Pat. No. 5,941,876 to Nardella et al. describes an electrosurgical apparatus that includes a rotary, tissue affecting device, such as a rotating blade component, a rotating drill, or a rotating shaving/ablating device. The rotating device also serves as an active, energy delivering electrode for electrosurgery.
U.S. Pat. No. 5,254,117 to Rigby et al. describes a multi-functional endoscopic probe apparatus capable of applying either a low or high frequency voltage to cut and cauterize tissue. The apparatus includes an elongated multi-lumen tube. The multi-lumen tube includes an irrigation lumen, a suction lumen, and a lumen providing passage for a slidably extendible and retractable electrosurgical cutting tip. The inner and outer surfaces of the multi-lumen tube can be coated with a layer of polyamide of uniform thickness for insulation. In some embodiments, the outer surface of the multi-lumen tube is further coated with a shrink-wrapped polytetrafluoroethylene insulating layer.
U.S. Pat. No. 5,429,596 to Arias et al. describes an endoscopic electrosurgical suction-irrigation instrument with insertable probes and attachments. The instrument includes a fluid chamber that is sealed at its proximal end, includes slit valve for receiving the probes, and is connected at its distal end to a cannula through which the inserted probes extend. The fluid chamber can be selectively provided with suction and/or irrigation and includes an electrical contact for supplying voltage to an inserted electrosurgical probe. Depending on the probe configuration, suction and/or irrigation can be provided in an annular space between the probe and the cannula or through the probe.
International Patent Application No. WO 97/24074 having inventors Isaacson et al. describes a hysteroscopic electrosurgical device. The device includes an electrosurgical probe, an irrigation channel, and an evacuation channel. In some configurations, a return electrode of the bipolar system provided by the instrument extends along an inner and/or outer surface of a sheath that is concentric about the positive electrode assembly.
While the above mentioned surgical instruments represent, in some instances, improvements over many prior art surgical instruments for performing open and minimally invasive surgical procedures, there remains a need in the art to provide surgical instruments which have improved cutting, ablation, grinding, and/or tissue cauterizing capabilities, and which also have the ability to be utilized in a wide variety of open and/or minimally invasive surgical procedures to perform a variety of surgical functions. The present invention provides, in many embodiments, such improved surgical instruments, and further provides methods for their use in a variety of surgical procedures.
The present invention provides a series of devices for performing surgical procedures utilizing electrodes for performing electrocautery on a tissue of the body of a patient. The invention includes, in one aspect, a series of devices comprising surgical instruments providing at least one electrode for performing electrocautery, and, in another aspect, provides a method for cutting and cauterizing tissue with a surgical instrument. In yet another aspect, the invention involves a method for detecting the location of a bleeding vessel in a liquid-filled, visually monitored surgical field of a patient and for electrocauterizing the vessel to stop the bleeding before visualization of the surgical field is compromised.
In one aspect, the invention provides a series of surgical devices with integrated electrocautery. One device comprises a surgical instrument having a distal end adapted to perform a surgical procedure on a patient and a proximal end controllable by an operator. The instrument includes a pressure lumen having sufficient burst strength to conduct a high pressure liquid towards the distal end of the instrument. The pressure lumen includes at least one nozzle providing a jet opening. The nozzle is shaped to form a liquid cutting jet as a liquid at high pressure flows therethrough. The instrument further includes a rotatable shaft and a surgical component drivable by the shaft and constructed and arranged for contact with tissue in a surgical operating field. The instrument further includes at least one electrocautery electrode.
Another device comprises a surgical instrument having a distal end adapted to perform a surgical procedure on a patient and a proximal end controllable by an operator. The instrument includes a rotatable shaft and a surgical component drivable by the shaft and constructed and arranged for contact with tissue in a surgical operating field. The instrument further includes a liquid jet-driven rotatable rotor drivingly coupled to the rotatable shaft, when the instrument is in operation, such that rotation of the liquid jet-driven rotatable rotor causes a corresponding rotation of the rotatable shaft. The instrument further includes at least one electrocautery electrode.
Yet another device comprises a surgical instrument having a distal end adapted to perform a surgical procedure on a patient and a proximal end adapted to be controllable by an operator. The instrument includes a pressure lumen having sufficient burst strength to conduct a high pressure liquid towards the distal end of the instrument. The pressure lumen includes at least one nozzle providing a jet opening. The nozzle is shaped to form a liquid cutting jet as a liquid at high pressure flows therethrough. The instrument further includes an evacuation lumen that includes a jet-receiving opening locatable opposite the jet opening at a predetermined distance therefrom to receive the liquid cutting jet when the instrument is in operation. The instrument further includes a first electrode comprising at least a portion of an external surface of the pressure lumen, and a second electrode comprising at least a portion of the external surface of the evacuation lumen.
Another device comprises a surgical instrument having a distal end adapted to perform a surgical procedure on a patient and a proximal end adapted to be controllable by an operator. The instrument includes a first lumen constructed of an electrically conducting material providing a first liquid passageway between the distal end and the proximal end of the instrument. The instrument includes a second lumen constructed of a conducting material providing a second liquid passageway between the distal end and the proximal end of the instrument. The first lumen is connectable in electrical communication with a first electrical potential. The first lumen has an external surface, at at least the distal end of the instrument, which is inserted into a surgical field of a patient when the instrument is utilized for a surgical procedure, that is coated with an essentially continuous layer of electrical insulation. The first lumen also includes an uninsulated region at its distal end that forms a first electrocautery electrode. The second lumen is connectable in electrical communication with a second electrical potential and has an external surface, at at least the distal end of the instrument, which is inserted into a surgical field of a patient when the instrument is utilized for a surgical procedure, that is electrically conductive and forms a second electrocautery electrode, except in a region at a distal end of the second lumen, which region at a distal end of the second lumen is coated with an essentially continuous layer of electrical insulation.
In another aspect, a method for performing a surgical procedure is described. The method comprises inserting a surgical instrument into a surgical field of patient, creating a liquid cutting jet with the surgical instrument, cutting or ablating a selected tissue of the patient with the liquid cutting jet, applying an electrical signal of at least one electrode of the surgical instrument, and cauterizing a tissue of the patient.
In yet another aspect, the invention provides a method for detecting the location of a bleeding vessel in a liquid-filled, visually monitored surgical field of a patient and for electrocauterizing the vessel to stop the bleeding before visualization of the surgical field is compromised. The method comprises inserting a surgical instrument into the surgical field of a patient, controllably evacuating a portion of the liquid from the surgical field with an evacuation lumen of the surgical instrument, visualizing a trail of blood originating at the bleeding vessel and flowing towards and into the evacuation lumen of the surgical instrument, moving the surgical instrument within the surgical field along the trail of blood towards the bleeding vessel, placing at least one electrode surface of the surgical instrument in proximity to the bleeding vessel, and applying an electrical signal to the electrode to electrocauterize the bleeding vessel to stop bleeding therefrom.
Other advantages, novel features, and objects of the invention will become apparent from the following detailed description of the invention when considered in conjunction with the accompanying drawings, which are schematic and which are not intended to be drawn to scale. In the figures, each identical or nearly identical component that is illustrated in various figures is represented by a single numeral. For purposes of clarity, not every component is labeled in every figure, nor is every component of each embodiment of the invention shown where illustration is not necessary to allow those of ordinary skill in the art to understand the invention.